Conditions Conducive to the Screening Auditory Brainstem Response Test: A Pilot Study

Early screening and identification of hearing loss is important to optimize hearing and speech outcomes. However, much is unknown regarding the youngest age and under what circumstances a premature infant may undergo an automated auditory brainstem response (AABR) screening in the neonatal intensive care unit (NICU) population. This study aimed to identify environmental factors conducive to AABR screening in the NICU population.

Premature infants in a tertiary, freestanding, 70-bed children's hospital level IV NICU were screened using Natus ALGO 3i AABR technology under the following circumstances: isolette crib, ventilation with RAM Cannula continuous positive airway pressure (CPAP), bubble CPAP, high-flow nasal cannula, nasal cannula, neurally adjusted ventilatory assist, tracheostomy tube, and room air.

Forty infants were enrolled in the pilot study. Of these, 29 (73%) were successfully screened, 4 (10%) screenings were unsuccessful, and 7 (18%) were inconclusive. A successful screening was defined as an AABR with good electrode impedance that ran to completion, regardless of test results. The youngest successful screen occurred at 33 weeks and 5 days. Screening success rates were highest in patients on room air (100%) and nasal cannula (100%), followed by high-flow nasal cannula (84%) and RAM CPAP (75%). Lower success rates were observed with bubble CPAP (17%), and isolette (50%). Screening was inconclusive for all invasively ventilated patients.

AABR screening is possible in the NICU under various circumstances, including assisted breathing. However, invasive ventilation interferes with accurate screening. Screening may be possible at younger gestational ages than previously recognized. Early detection supports improved outcomes and adherence to Joint Committee on Infant Hearing 1-3-6 guidelines.